ICT16-109 NRH EPR Business Case - eHealth Ireland...safety, with relatively modest investment, and with a high degree of confidence. Informed Investment Strategy In view of the opening

CONFIDENTIAL June 2016

EPR Business Case

Electronic Patient Record Business Case

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Contents

Executive Summary ..................................................................................................................................... 3

High-level Financial Benefits ....................................................................................................................... 7

Document Purpose & Structure ................................................................................................................. 8

Introduction ................................................................................................................................................ 9

ICT Solution Overview ................................................................................................................................. 9

The Operational Case ................................................................................................................................ 11

The Strategic Case ..................................................................................................................................... 15

Solution Overview ..................................................................................................................................... 17

ProposedHigh-levelFunctionality....................................................................................................18

Benefits Overview ..................................................................................................................................... 18

AnticipatedFinancialBenefits..........................................................................................................18

BenefitsDetail..................................................................................................................................19

Programme Governance ........................................................................................................................... 23

Implementation Timeline ......................................................................................................................... 24

Risk Management ..................................................................................................................................... 24

Key Assumptions / Qualifications ............................................................................................................. 27


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Executive Summary

The migration to EPR is a pillar of HSE vision and strategy. It is also at the heart of delivering

functionality which could support the National Clinical Programme for Rehabilitation Medicine and

Neuro-Rehabilitation Strategy at local, regional and national levels. With a move to a new hospital

building in 2019 resulting in a much greater geographical

footprint the functionality provided by an EPR is seen as

essential. Furthermore, it is central to the NRH mission

and strategy to optimise use of its scarce resources to

enable provision of the best possible quality, safe and risk

adverse patient care.

This business case proposes the early deployment of both a Patient Administrat ion

System (PAS) and Electronic Patient Record (EPR) in the NRH. Ideal ly both sets of

functional ity wi l l be avai lable as one t ightly integrated appl icat ion suite.

Note: the terms PAS and EPR wil l be referred to as EPR within this business case.

The case illustrates why the NRH is uniquely placed to help the HSE to advance its EPR objectives in

common with those of the eHealth Ireland Electronic Health Record (HER) strategy; and

simultaneously help the NRH to protect and maintain its quality of patient care.


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Why the NRH is uniquely and best placed for an EPR?

National Showcase

The nature and scale of the NRH, make it an ideal flagship location in which

to prove and learn about the impacts of EPR on a medium sized hospital, the

challenges involved and best strategies for deployment.

Low Risk The NRH provides an environment in which this can be achieved in relative

safety, with relatively modest investment, and with a high degree of

confidence.

Informed Investment

Strategy

In view of the opening new hospital in Q1 2019, timing is of the essence for

the NRH. As a result, the HSE will benefit from an early result and feedback

which will help inform and protect future HSE supported EPR investments

Proven Change

Leadership

Delivery of the EPR is complex in its own right, but it is only half the story.

The ability to successfully manage the ‘people’ elements of the EPR change

programme is critical to enabling the widespread process and behavioural

changes required, and to generate the benefits. The NRH has proven ability

to successfully lead and deliver such major transformational change.

Management Commitment

This proposal has the full commitment of the Board, Executive, Clinical,

Programme, Nursing and Allied Health Professional teams to make it happen.


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EPR is key to achieving

HSE, national and NRH

strategies

The reliance on outdated paper based patient files is an impediment to the

successful achievement of the HSE, Rehabilitation Medicine Programme,

Neuro-Rehabilitation and NRH strategies – all of which seek to optimise use

of its scarce resources to enable provision of the best possible quality of

patient care, where it is need, when it is needed, and in a manner which is

truly patient centric.

EPR addresses

exist ing r isks and

ineff ic iencies

The following three NRH specific examples illustrate how an EPR will directly

address existing inefficiency and risk whilst simultaneously improving patient

care:

• Rehabilitation is unique within healthcare to the extent to which patients are

mobile with patients on average travel l ing upwards of 2km

between treatments within the NRH today. This requires the patient

record to follow the patient and be available at the ‘point of care’, and to be

secure at all times – this is labour intensive, inefficient, and in practice,

impossible to achieve with paper files, and whilst fully respecting protocols.

Different medical specialists and therapists also require access to the

patients’ records simultaneously which is not possible. This creates the risk

of incorrect decisions being made on incomplete information. It may also

result in delayed discharge due to the patient records not being updated

appropriately.

• The NRH is fundamentally a ‘therapy’ hospital however, the schedul ing of

patient therapy and the production of patient t imetables is

manual and as a result complex, cumbersome and inefficient. The process,

by necessity conducted by clinicians, therapists and administration staff, falls

well short of being patient-centric.

• Patient files must currently be copied and the physical copies must travel off-

campus with authorised staff for liaison services and pre-admissions - with

inherent data protection and data pollution risks (confusion between master


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and copy records).

EPR is essentia l to

the New Hospital

The new Hospital will require medical, clinical, therapy and administrative

operations to be spread over yet further, more physically dispersed locations

throughout the hospital campus (with up to 410 metres between

buildings/locations). To compound this issue, the development of the new

hospital is being phased over two and possibly three phases, so staff will

have to operate from two separate accommodation blocks making the

management of charts that more difficult. One of the fundamental

responsibilities of the NRH as an internationally accredited rehabilitation

facility is to affect positive change in functional ability and independence and

self-reliance across environments, while protecting and promoting the rights

of patients. The new hospital design creates an environment specifically to

facilitate rehabilitation and its related service processes, delivered by an

integrated team which includes the patients. The intent behind designing the

integrated therapeutic and social areas in the new building is to create

flexible multifunctional space to support an interdisciplinary team approach

to programme delivery rather than a multidisciplinary team approach. The

adoption of an EPR will support and enhance this model of working, creating

opportunities for effective team working and communication which in turn

enhances the quality and efficiency of the service being provided by the NRH

to our patients and other stakeholders.


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High- level F inancial Benefits

The EPR will enable HSE, national and hospital strategies, all of which are singularly aimed at utilising

all available resources to provide best possible patient care.

The NRH Board and Executive commend this proposal.

Non-financial Benefits

Clinical and Patient Benefits

• more time for direct patient care

• access to clinical information at the point of care

• input to the patient record at the point of care and in real time

• improved patient safety and richer patient experiences

• significant clinical and patient benefits with better quality outcomes

• improved clinical governance through an integrated health record and more timely and

accurate decision making

• more complete and accurate generic patient data for medical research purposes.

Management & Staff Benefits

• accurate and timely management information (MIS) for NRH management

• better intrinsic rewards for staff through a richer, more interesting, workplace with less

routine tasks

• less duplication of data and improved management information across NRH.

HSE Benefits

• better quality MIS reporting from NRH to HSE

• the programme will support the HSE’s Better Safer Health Initiative

• EPR can benefit HSE National Rehabilitation Medicine Programme as it could be rolled out to

the regional and community based rehabilitation centres in due course. In effect we would

have a single integrated approach to rehabilitation services nationally.


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Document Purpose & Structure

This Business Case document sets out the scope of the NRH EPR Programme along with the expected

cost, outcomes, and how programme will be managed.

The document is structured as follows:

Introduction & Strategic

Case

Demonstrates how the NRH EPR Programme is wholly aligned to NRH and

HSE vision and strategy, and critically, why the introduction of an EPR is an

desirable prerequisite to the opening of the new Hospital in 2019.

ICT Solut ion Overview

Demonstrates why an EPR solution is required, the scope of the solution

and how it will be delivered.

Benefits Case Demonstrates the high-level benefits, and how these benefits will be

managed and realised.

F inancial Case Demonstrates the overall investment case.

Management Case

Demonstrates how the overall change programme will be governed and

managed throughout its lifecycle.

Key Assumptions

Highlights the assumptions on which the proposal is based.

R isk Management

Main risks and mitigants


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Introduction

The National Rehabilitation Hospital, NRH, is a CARF1 accredited voluntary teaching hospital in Dun

Laoghaire, Co. Dublin. The hospital currently has 110 in-patient beds and an active outpatients

department (OPD). Each year the hospital treats 620 in-patients and carries out over 13,000 out-

patients sessions with a complement of approximately 450 FTE staff. In line with international best

practice in-patient average lengths of stays (AVLOS) have reduced from 79 days (2008) to 71 days

(2013) as patients receive rehabilitation therapies to help their recovery from severe neurological

injuries, (brain or spinal cord) or limb absence injuries. The hospital has an excellent reputation and is

the national centre of excellence for rehabilitation services.

In developing this business case we consulted widely with NRH clinicians, program managers and

patient administration system (PAS) users. We also linked in with the HSE National Clinical

Programme for Rehabilitation Medicine to ensure that the proposed NRH transformation programme

conformed with best practice and that the transformation programme would be relevant not only for

NRH itself but could also be rolled out to the proposed regional and community based rehabilitation

centres in due course. We also reviewed HSE’s strategy to ensure this business case was

appropriately aligned with HSE’s overall direction specifically the eHealth Ireland Strategic

Programme.

ICT Solut ion Overview

NRH is a major user of a legacy patient administration system (PAS) which is used extensively in HSE

hospitals across the country. The proposal envisages the deployment of a single instance, single

individual patient record EPR to support the delivery of Rehabilitation within the NRH within the

context of an increased more complex footprint, as a result of the New Hospital build, and a move

away from traditional nightingale ward to single patient rooms. Care within the inpatient

rehabilitation environment is delivered campus wide and not, in the main, delivered at the bed side as

would be the case in acute hospitals. Since the NRH is a tertiary care provider, first contact is made

with patients within the acute sector where NRH consultants and pre-admission coordinators provide

1CARFisanindependentnon-profitorganisationthatprovidesinternationalaccreditationtoprovidersthatdeliverrehabilitationservicestothecommunity.Detailsareatwww.carf.org


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clinical input while referring patients back to the NRH. The solution should provide functionality to

support the capture of pre-admission data by NRH staff. Pre-admission data is vital to ensure that

levels of complexity can be identified so that patients can be admitted to a set number of beds

available for each complexity level as well as managing equity of access.

Managing the inpatient phase of care is very different in the rehabilitation setting with patients

attending numerous therapy sessions on a daily basis. As a result, access to the patient record at the

point of care is not always possible. In addition significant clinical and therapy resources are used in

creating and managing patient diaries. Access to scheduling functionality would result in significant

time savings and a better use of scares clinical and therapeutic resources. Likewise access at the point

of care to an electronic form of the patient record would result in better safer and more efficient

care.

In addition to inpatient care, the NRH operates significant outpatient and community (liaison) based

services. The Neuro-Rehabilitation Plan would see services deployed country wide and it is our plan to

support this network via the use of a single electronic patient record. Post discharge and unlike the

acute sector, both Spinal and Brain Injury patients are monitored for life. EPR functionality supporting

care across this continuum is therefore vital if the NRH is to manage risk, deliver safe and effective

care and ultimately prevent readmission to the acute service or directly to the NRH.

Core Functionality Requirement

Patient Master Index (PAS) Bed Management

Clinical and Therapy Noting Clinical Coding

Therapies Referral Management

Nursing Obs and Documentation eDischarge

Inpatient Management Management Information

Outpatient Management User Defined Assessments

Integrated Clinical Pathways External Communications (correspondence)

Standardised messaging (HL7) Lab Integration via Healthlink


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Single Instance Adoption of National Strategies

Note: I t should be noted that the NRH is seeking to deploy a standalone s ingle

instance EPR.

The Operational Case

The operational case for EPR is also already well accepted.

However, the following examples help to illustrate why the

NRH is unique in comparison to other hospitals, and

consequently there is a significant win-win type opportunity

to directly address existing inefficiencies and risks whilst

simultaneously improving patient care:

• Patient files must currently be copied and the physical copies must travel off-campus with

authorised staff for liaison services and pre-admissions - with inherent data protection and data

pollution risks could occur (confusion between master and copy records).

• The NRH is unique to the extent to which patients are mobile

(travel up to 2km per day) as they move between therapy

sessions. This requires the patient record to follow the patient

and be available at the ‘point of care’, and to be secure at all

times – this is labour intensive, inefficient, and in practice,

impossible to achieve with paper files, and whilst fully respecting

protocols. Different medical specialists, therapists and

administrative functions also require access to the patients’

records simultaneously which is not possible. This creates the risk of incorrect decisions being

made on incomplete information. It may also result in delayed discharge due to the patient

records not being updated appropriately.

• The NRH is an internationally accredited rehabilitation hospital and is critically aware of the need

for efficient management of resources and continuous improvement. A key requirement for the

EPR is inpatient therapy scheduling functionality. The provision of this functionality is a key


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enabler in supporting the NRH to free up both clinicians and therapists time from administrative

work to direct patient contact.

• A further differentiating feature is that the NRH manages the patient’s journey through the

services from the time they are referred and placed on our waiting list. This supports an

integrated care model, which is also a national clinical programme offering patient centred, co-

ordinated care. With appropriate access to an EPR, availability of the requisite patient

information would promote admission to the various points of the rehab continuum. As tertiary

provider/ specialist the NRH has the potential to integrate neuro-rehabilitation through this

continuum, in turn supporting the achievement of HSE and NRH goals and helping NRH offer the

highest quality of care.

• As a result of our central waiting list management system as an elective service, the NRH

manages all patients on that list from a central location with the centrally held paper record. In

order for multiple users i.e. consultants, liaison nurses, pre-admission coordinators to provide

clinical input, get updates, respond or advise local teams e.g. Kerry/ Waterford/ Cork/

Roscommon/ Letterkenny, they require access to the file at the point of contact. Routinely when

replying to requests NRH consultant cannot access the file and therefore ensure they are

working off the most up to date patient information. This is replicated across all the above

personnel and introduces unnecessary delays. The movement of charts can also result in charts

becoming mislaid or in some cases lost.

• In Q1 2019, the first phase of the new hospital development will

open. The New Hospital is being redeveloped in Phases due to

funding constraints. The brief for the first phase of the hospital is

to provide ward accommodation with integrated therapy spaces.

The new building will comprised of fit for purpose 120 single

rooms with ensuite facilities, programme specific integrated

therapy spaces on each ward, living and social spaces and ward

clinical and ancillary facilities. The brief for the second phase of

the hospital redevelopment will include all elements of the

hospital not included in the scope of phase 1. This environmental

separation of facilities poses significant logistical and communication challenges for the


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organisation. The delivery of an EPR will mitigate against many of the associated risks to patient

safety that are caused by delivery of care across different geographical locations. The NRH

evolution to a new modern healthcare facility will be a showcase for healthcare buildings in

Ireland and the wider International Healthcare Community. Consequently, increasing use of

technology for patient care and improving patient outcomes is central for successful project

delivery.

• This phase incorporates 120 private rooms in a new accommodation block adjacent to the old

main hospital. The temporary, but long-term, new layout (with up to 410 metres between

buildings/locations) will operate indefinitely, and until such times as the requisite funding and

permissions are secured and remaining works completed, which will consolidate hospital

operations bringing the medical, clinical, therapy and related administrative functions together.

In the absence of EPR, the hospital will struggle to maintain the quality of patient care, and it will

exacerbate the pressure on resourcing - which will already be stretched as hospital operations

transition to the new environment and at the same time are reshaped to deliver

programmatically rather than departmentally.

• The ability of a fully deployed EPR at the NRH will enable the hospital to manage waiting lists

better while transitioning patients through the care pathway more efficiently. These efficiencies

should see an increase in inpatient throughput and as a result will have a direct impact on acute

feeder hospitals.

• The ability of an EPR to fully and electronically document patient outcomes will enable the NRH

meets national guidelines for the production of discharge summaries. The NRH is keep to ensure

that relevant patient data and patient discharge summaries are available on discharge and can

quickly be made available to the patients GP and or Patient Support Services such as Acquired

Brain Injury Ireland, BRÍ, Headway, Ability Matters, Spinal Injuries Ireland, and the Irish

Wheelchair Association. It is essential that GP’s and agencies have relevant patient data to

support patients in their home and to prevent readmissions to either the acute sector or the

NRH.


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Some general examples:

Significant efficiencies and better decision making can be achieved with the implementation of an EPR

at the NRH as management, administrative and indeed clinical time spent reconciling data from

multiple, and in some cases paper based sources can be prevented. The NRH invests significant

overheads in the production and validation of business information for both internal and external

reporting agencies (e.g. HSE, ESRI, NTMA, etc.). An EPR would also support the production of ad-hoc

reports which in many cases currently require staff to pull charts and extract data manually.

PAS cannot deal with suspended beds (e.g. where inpatients are returned to an acute hospital for

treatment), inpatients temporarily returning home as part of their treatment or with inpatients who

attend NRH on a split week basis (e.g. Mondays, Wednesdays and Fridays).

Legislation requires that patient medical records be kept for many years and there are costs in storing

archived medical records on-site in secure locations. For example NRH delivers complex rehabilitation

services to people who have sustained catastrophic injuries due to road traffic accidents and medical

records are required for medical/legal purposes. Similarly there are administrative costs and

overheads incurred in managing these records and there is a risk of highly confidential documentation

being mislaid or misfiled in the process. We want to inhibit growth in archiving of paper records and

reduce costs managing same.

Insummary,theNRHhasanimmediateneedforanEPRtosupportachievementofHSE,National

andNRHstrategies.Itisalsokeytoaddressingexistingefficiencyandriskissues,andtofurtherits

objectiveofachievetruepatientcentriccare.Furthermore,intheabsenceofanEPRtheexisting

inefficienciesandriskswillbeexacerbated,making it increasinglydifficultmaintainstandardsof

patient care, and placing increased pressure on already stretched resources coping with the

transitiontothenewhospitalandaprogrammaticapproachtoservicedelivery.


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The Strategic Case

The compelling case for EPR is already well accepted both nationally and internationally, and

migration to an EPR is already a key element the HSE vision and strategy.

Access to an EPR is also at the heart of enabling and delivering on Neuro-Rehabilitation strategy at

local, regional and national levels by delivering an integrated care model which is supported by the

national clinical programme, as well as being central to the NRH mission and strategy to optimise use

of its scarce resources to provide the best possible quality of patient centred care.

The national strategy for the future provision of Neuro-Rehabilitation is based on a hub and spoke

model. The patient moves through the rehabilitation continuum from acute to tertiary and then

returning to secondary/ regional services. Secure, comprehensive, effective and timely information is

essential to support this patient journey through these complex services. The NRH provides these

outreach services nationally across each of its brain, Stroke, spinal, POLAR and paediatric

programmes. A single instance Rehabilitation EPR can support and enable this strategy by providing a

single rehabilitation electronic medical record.

The reliance on paper based patient files is an impediment to successful achievement of each of the

Neuro-Rehabilitation Strategy and NRH strategies – all of which seek to optimise use of its scarce

resources to enable provision of the best possible quality of patient care, where it is need, when it is

needed, and in a manner which is truly patient centric.

• The nature and scale of the NRH, make it an ideal flagship location in which to prove and

learn about the impacts of EPR on a medium sized hospital, the challenges involved and best

strategies for deployment.

• The NRH provides an environment in which this can be achieved in relative safety, with

relatively modest investment, and with a high degree of confidence.

• In view of the opening new hospital in Q1 2019 timing is of the essence for the NRH as the

change management effort required needs to be implemented in advance of this move. The

provision of an EPR is essential to ensure effective, safe and risk adverse patient care.


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• This proposal has the full commitment of the Board, Medical Director, Executive, Clinical,

Programme, Nursing and Allied Health Professional teams to make it happen.

The NRH manages the patient’s journey through the services from the time they are referred and

placed on our waiting list, which is a unique feature. This supports an integrated care model, which is

also a national clinical programme offering patient centred, co-ordinated care. With appropriate

access to an EPR, availability of the requisite patient information will promote admission to the

various points of the rehab continuum. As tertiary provider/ specialists the NRH has the potential to

integrate Neuro-Rehabilitation through this continuum, in turn supporting the achievement of HSE

and NRH goals while helping NRH offer the highest quality of care.

Provision of the best possible patient care has always been, and will always be, at the centre of the

NRH mission and goals. The development of the new hospital is key component in the future delivery

on these objectives. To achieve this, we must make the very best use of our scarce resources and our

amenities. In the absence of an EPR we struggle to maintain the current level of patient care whilst

we transition to the new hospital environment, and with absolute certainty, we will fail to make best

use of scarce resources.

Without access to an EPR the NRH will continue to struggle to gain access to appropriate patient data

and, management information and analytics. An EPR is therefore vital to ensure, not only high quality

care but also to provide management with information about financial and operations aspects of

hospital management.

Access to an EPR will help fulfil national Neuro-Rehabilitation and NRH strategic objectives. The NRH

is ideally placed for success. As the national centre leading rehabilitative medicine, it is also ideally

placed as a flagship and model for EPR. It needs EPR and has the change leadership capability to

deliver it. It has the drive, commitment and support throughout the organisation.

In summary, an EPR is a key enabler for each of these strategies. Access to patient

information, where it is needed, when it is needed, and in a control led and secure

manner, is a cornerstone to the del ivery of true patient-centred, interdisc ipl inary

rehabi l i tat ion.

The NRH team is both willing and able and, it will ensure EPR is an unqualified success.


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Solut ion Overview

The NRH is seeking an EPR which will allow the hospital to effectively manage the entire Patient

Journey, capture all relevant data for rehabilitation, review, clinical reporting and governance

requirements.

The proposed solution will deliver the necessary platform to create a paper-light hospital which

eliminates the need for expensive paper record storage and management and importantly provides

access to data at the right time and within the right place. This is crucial in a distributed hospital

environment, such as the NRH.

By storing and sharing health information electronically in a single record and in real time, the EPR will

speed up clinical communications, reduces the number of errors and assists healthcare professionals

with the diagnosis and treatment of patients by allowing them to follow predefined integrated Clinical

Care Pathways.

The EPR will have user configurable functionality which will allow assessment tools (Bartel Index, Fim ,

Fim+Fam ect) and forms used within Therapy, and by other health care professionals to be easily

developed by internal hospital IT staff. Access to these tools is vital to ensure that all relevant data is

held centrally at a patient level within the EPR.

I t is essentia l that any solut ion wi l l include a ful ly functioning Patient Administrat ion

System designed for or configurable to meet the needs of the Ir ish Health Service.

The Vendor wi l l be required to del iver a l l current and future Ir ish specif ic legis lat ive

requirements, such as the Indiv idual Health Identif ier ( IHI) during the l i fe t ime of

the contract. I t is envisaged that no local isat ion wil l be required ful ly implement

both the EPR and PAS functional ity .


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Proposed High-level Functional ity

• Patient Administration System - PAS

• Bed Management

• Clinical Coding

• Clinical and Therapy Noting

• Therapies

• Referral Management

• eDischarge

• Management Information

• Nursing Obs and Documentation

• User Defined Assessments

• Inpatient Management

• Outpatient Management

• External Communications

• Integrated Clinical Pathways

• Standardised 3rd Party Interfaces

• Individual Health Identifier (IHI)

Benefits Overview

An EPR is central to providing the best quality, safe and risk adverse patient care and clinical

outcomes. Furthermore, the data gathered will inform how best to deliver the care programmes so

as not only to achieve best clinical outcomes, but also to accelerate discharges, and to reduce and

minimise the demands on resources post discharge.

Antic ipated Financial Benefits

€0.5m pa recurr ing

Est imated

• Anticipated savings based on research of 8 person days per month

(@ €200 per day) on internal and external MIS reporting assuming

reports will be generated automatically and data MI will be

accessible to management.

• Administration synergies can be achieved through efficient

workflow that will enable up to four staff in the NRH to be

redeployed in the hospital over a two year time frame.

• It is anticipated that clinical synergies, proactive patient

management and better access to patient flow would result in a

reduction in an average length of stay per inpatient at a saving of

€500 per patient day. A reduction in AVLOS is backed up by


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l i terature.

• Efficiencies in preparing interdisciplinary discharge reports,

equivalent to one day for 620 inpatients per annum at a cost of

€300 per day.

• On this basis we estimate that an EPR meeting the specific needs of

rehabilitation will yield savings of €5.9 million over 10 years,

equivalent to a Net Present Value (NPV) of €0.5 million using a 6%

annual discount rate. Alternatively the EPR transformation

programme generates an internal rate of return (IRR) of 12.1%. For

a programme of such strategic importance to NRH, these are

attractive financial returns.

Benefits Detai l

C l in ical and Patient

Benefits

• Care Pathways providing Improved quality patient care, greater

patient centricity of care, safety and richer patient experiences

• Integrated multidisciplinary integrated care pathways

• Improved overall patient outcomes

• Up-to-date information on patient flow

• Supporting discharge planning from the point of admission,

identifying potential complex discharges.

• Supporting patient pathways

• Reductions in Length of Stay

• Improved clinical governance through an integrated health record

and more timely and accurate decision making

• Clinical decision support

• Access to patient notes at the right time in the right place


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• More time for direct patient care

• More complete and accurate generic patient data for medical

research purposes

Management & Staff

Benefits

• Accurate and timely management information (MIS) resulting in

better and more rapid decision making

• Less duplication

• Better working environment for staff through a richer, more

interesting, workplace with less routine tasks

NRH Benefits • Improved efficiency and safer delivery of care

• Reductions in Risk

• Key enabler for the new hospital

• Key enabler to achieving NRH strategic goals

• Access to accurate quality data for planning and research

HSE Benefits

• Key enabler for National Neuro-Rehabilitation strategies

• Support eHealth Ireland Strategic Programme

• Supports the Better Safer Health Initiative.


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Examples of other Benefits

• On referral, inpatient information will be recorded once in EPR but used many times, the clinical

pathways module would define the treatment route for inpatients and patient records will be

updated by clinicians, nurses, therapists immediately post treatment. The production of

inpatient interdisciplinary discharge reports that comply with HSE policy is a lengthy manual and

complex process in the NRH today but with accurate and complete patient records EPR can

generate patient discharge reports quickly. This enhanced workflow would improve patient

satisfaction, shorten patient treatment programmes, reduce average length of stays and shorten

inpatient waiting lists.

• Similarly attendance at outpatients department (OPD) will improve through a reduction in Did

Not Attend (DNA) and Unable to Attend (UAT) statistics as the EPR should can generate text

messages automatically to remind patients of their date and time of appointment. Increased

patient throughput would reduce OPD waiting lists and increase patient satisfaction. DNA and

UAT rates can be measured before EPR deployment and then post implementation to calculate

the improvement. We estimate that we could run up to 500 additional out-patient sessions per

annum.

• In the NRH’s spinal program, international best practice mandates that patients are tracked for

life (this is also a CARF requirement). Increasingly, this applies to people who are in need of

complex specialised rehabilitation. With quality long term data, patient outcomes can be

reviewed easily and inpatient re-admission rates to local acute hospitals can be reduced through

better patient education and treatment in OPD as necessary. A similar situation arises in

Paediatrics where children have to tracked and moved to adult programmes as appropriate.

• Once the EPR has gone live in the NRH it will deliver clinical, medical and administration benefits,

and it will produce KPIs that are required by National Rehabilitation Medicine Programme

(NRMP) on a regular basis. The solution should then be rolled out to the proposed regional

rehabilitation centres and in time to the community based centres. This means there could be

one standard EPR system delivering the reporting requirements of NRMP which is important at a

national level.


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• Data from the EPR, can be married with data from other NRH systems such as CoreHR, to assist

and underpin CARF accreditation, inform how resources are best deployed and services offered,

and aid the migration from Departmental to the programmatic approach to patient care.


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Programme Governance

NRH will establish a Programme Board which will be responsible for implementation and ensuring

that the programme delivers to specification, on schedule and within budget.

The CEO is the Senior Executive Sponsor, on behalf of the Board. The Clinical Director will be the

Senior Executive Owner with overall responsibility for delivery of the programme, recognising the very

significant impacts on, and behavioural changes required on the part of, the medical, nursing and

health professional teams across the entire Hospital.

The Programme Board will be chaired by the Senior Executive Owner, and will comprise senior

representatives from across the organisation including the CEO, HR, ICT, Risk, Clinical, Nursing, and

Allied Health Professional teams. Responsible line managers and the Programme Board will formally

sign off on business requirements, timelines, budgets, risks and benefits, and will oversee the delivery

and achievement of all deadlines and outcomes. Sub-groups will be used and tasked as required.

Benefits will be individually owned by the relevant line managers, who will be accountable to the

Programme Board for realisation of the assigned benefits.

The NRH has an excellent track record of managing within its budget and is experienced in managing

large change projects such as the recent HR Transformation Programme, and the on-going Health

Planning (New Hospital) project. Phase 1 of the New Hospital Development, has an approved project

budget of €55m with an assumed higher construction budget.

The programme will comprise several work streams including clinical, nursing, therapies,

administration, social work, information technology, data migration, user training and benefits

realisation. Proper project management principles will to adhered to which will include clinical

ownership of the project via the Medical Director, the establishment of a strong project board which

will include external members, a dedicated full time project team, and suitably qualified and

experienced project manager. Senior NRH staff will lead these work streams to ensure they are

successful.


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Implementation Timeline

Details of the programme high level timeline are set out below. The expectation is the programme

can be completed within 12 to 18 months but more detailed planning will be required to validate this

timeline at programme initiation stage. Full resource estimates will also be validated at programme

initiation stage. It is likely, based on experience that the project will require a fulltime team of five, led

by a project manager, and supplemented by relevant departmental staff, as needed, during the life of

the project.

R isk Management

Budgets & Timelines

• The programme budget and timelines may over-run.

Key Mitigants:

- The Programme Board will comprise suitable qualified senior

HRH personnel, who will review the scope, time, quality, cost

and benefits objectives in detail.

- A best practice ‘clarify the change’ method/tool will be used

to ensure full understanding of each component.

- Relevant executives, manager and the Programme Board will

sign of off the detailed programme deliverables.

- A senior member of hospital staff will own and be responsible

for each deliverable, and each benefit.

Lack of Buy-In

• The business process change is not communicated effectively and

there is little “buy in” from staff.

Key Mitigants:

- Best change management practice will be applied across the


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programme. By its nature this includes securing the right

involvement, ensuring effective and timely communication,

the right level of engagement, ensuring understanding and

support managers and staff throughout the change.

- Best change management practice also demands the highest

order of change leadership, publically and privately, from the

Board, CEO, Executive team, Change Owner and from line

managers. The NRH understands this, and will integrate all

the required actions and effort and required monitoring into

its programme plan, and its day to day management activities.

Data Migrat ion

• Data migration from the old PAS system is a complex and

resource intensive task.

Key Mitigants:

- A separate work stream will be established at an early stage

to manage this process, to validate that data can be migrated,

to determine the size and scope of the data to be migrated,

to cleanse the data as necessary and to ensure its accuracy.

Benefits - The programme benefits may not be realised or are only

partially realised. Proper project management principles

need to adhered to which will include clinical ownership of

the project via the Medical Director, the establishment of a

strong project board which will include external members, a

dedicated full time project team, and suitably qualified and

experienced project manager. Risks are further mitigated by

assigning owners to the benefits realisation work stream, by


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defining performance metrics to measure and record success

and ensuring that all staff using the EPR are fully trained.


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Key Assumptions / Qual i f icat ions

The main assumptions supporting the business case are set out below.

• NRH will work in close partnership with the EPR vendor throughout the project which is

expected to take 12 to 18 months to complete once the project is approved, contract signed

and respective teams are mobilised. Since the window of opportunity is approximately two

years, the NRH would hope to have a project start date of Q1 2017.

• NRH will support the project by committing six staff to the project for 12 to 18 months. It may

be necessary to backfill some of these staff resources as required.

• NRH will assign a project / change manager, on a full time bases, on a fixed fee basis following

competition.

• Hardware maintenance and support costs are estimated at €15,000 per annum (including

VAT) following expiry of one year warranty.

• All clinical, medical, nursing and administration staff in the NRH will receive and estimated

two days training on the new system.

• The Vendor will be required to deliver all current and future Irish specific legislative

requirements, such as the Individual Health Identifier (IHI) during the life time of the contract.

• NolocalisationwillberequiredfullyimplementboththeEPRandPASfunctionality.

• ThePASwillcomplywithorcanbeconfiguredtocomplywithallIrishPASrequirements.

Documents

ICT16-109 NRH EPR Business Case - eHealth Ireland...safety, with relatively modest investment, and with a high degree of confidence. Informed Investment Strategy In view of the opening